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Can a Shared Decision Making Tool Improve Multiple Sclerosis Dmt Utilization? the MS-Support Decision Aid

Thursday, June 2, 2022
Prince George's Exhibit Hall (Gaylord National Resort & Convention Center)
Nananda F Col, MD, MPH, MPP, FACP , Shared Decision Making Resources, Professor of Medicine, ME
Andrew J Solomon, MD , Neurological Sciences, University of Vermont College of Medicine, Burlington, VT
Enrique Alvarez, MD, PhD, MSCI , Department of Neurology, University of Colorado, Aurora, CO
Lori Pbert, PhD , University of Massachusetts Chan Medical School, Worcester, MA
Carolina Ionete, MD, PhD , Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, MA
Idanis Berrios-Morales, MD , Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, MA
Jennifer Chester, FNP-BC, MSCN , Kansas City MS Center at College Park Specialty, Overland Park, KS
Christen Kutz, PhD, PA-C , Colorado Springs Neurological Associates, Colorado Springs, CO
Crystal Iwuchukwu, RN, BSN, FNP , Southeast Health, Cape Girardeau, MO
Terrie Livingston, PharmD , EMD Serono, Inc., an affiliate of Merck KGaA, Darmstadt, MA, Germany
Vicky Springmann, MSc , Shared Decision Making Resources, Georgetown, ME
Hannah V Col, MS (c) , Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, MD, Statistics, Shared Decision Making Resources, Georgetown, ME
Long H Ngo, , PhD , Biostatistics, Beth Israel Deaconess Medical Center, Boston, MA
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Background:

Disease-modifying therapies (DMTs) can slow disease progression in people with MS (pwMS), but utilization is suboptimal in some groups. We developed a decision aid to help pwMS choose treatment.

Objectives:

To assess the impact of a shared decision-making tool (MS-SUPPORT) on DMT utilization.

Methods:

We conducted a randomized controlled study comparing MS-SUPPORT with usual care (control). People with relapsing MS were referred by clinicians or patient networks. The MS-SUPPORT group viewed the interactive tool online before their MS appointment; the tool generates a concise summary of the goals and preferences of pwMS and shares it with their HCPs.

Patient-reported DMT use was assessed at enrollment (T0), post-appointment, and quarterly for 1 year. We calculated the proportion of current DMT use and the cumulative probability of starting any DMT. We used generalized estimating equations to estimate the probability ratio (MS-SUPPORT to control) of current DMT use over time. We used Kaplan-Meier product limit analysis on time to start of any DMT to obtain the cumulative probability of starting a DMT.

Results:

501 pwMS (84.6% female, 83% white, mean age 48.4) were randomized to MS-SUPPORT (262) or control (239) groups. At T0, 80.2% were current DMT-users and 19.8% nonusers (16.2% past-users, 3.6% never-users).

Among nonusers at T0, the probability ratio of current DMT use consistently trended higher in the MS-SUPPORT group (vs. control) at all time points, with an overall effect of 1.30 (95% CI, 0.86-1.96). The probability ratio was 1.59 post-appointment, 1.31 at 3 months, 1.26 at 9 months, and 1.27 at 1 year.

Among nonusers at T0 who started DMT, median time-to-start trended shorter for the MS-Study group vs. the control (46 vs. 90 days, p=0.24). Kaplan-Meier analysis shows that within 6 months of observation, the cumulative probability of starting a DMT trended consistently higher in the MS-SUPPORT group. At 30 days, the cumulative probability of starting a DMT was 28% in the MS-SUPPORT group vs. 12% in the control; at 6 months, these probabilities were 55% vs. 50%, respectively.

DMT-users at T0 in the MS-SUPPORT group trended slightly more likely to continue use at 3-month follow-up, compared with control (97.3% vs. 93.8%, p=0.17), but not afterward.

Conclusions:

PwMS using MS-SUPPORT trended towards more DMT use and shorter time-to-start within 6 months. MS-SUPPORT was given at one time point; consistent reinforcement may be needed for a more durable impact.

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